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Abstract Yellow fever outbreaks are prevalent, particularly in endemic regions. Given the lack of an established treatment for this disease, significant attention has been directed toward managing this arbovirus. In response, we developed a multiepitope vaccine designed to elicit an immune response, utilizing advanced immunoinformatic and molecular modeling techniques. To achieve this, we predicted B- and T-cell epitopes using the sequences from all structural (E, prM, and C) and nonstructural proteins of 196 YFV strains. Through comprehensive analysis, we identified 10 cytotoxic T-lymphocyte (CTL) and 5T-helper (Th) epitopes that exhibited overlap with B-lymphocyte epitopes. These epitopes were further evaluated for their affinity to a wide range of human leukocyte antigen system alleles and were rigorously tested for antigenicity, immunogenicity, allergenicity, toxicity, and conservation. These epitopes were linked to an adjuvant ( $$\beta$$ β -defensin) and to each other using ligands, resulting in a vaccine sequence with appropriate physicochemical properties. The 3D structure of this sequence was created, improved, and quality checked; then it was anchored to the Toll-like receptor. Molecular Dynamics and Quantum Mechanics/Molecular Mechanics simulations were employed to enhance the accuracy of docking calculations, with the QM portion of the simulations carried out utilizing the density functional theory formalism. Moreover, the inoculation model was able to provide an optimal codon sequence that was inserted into the pET-28a( +) vector for in silico cloning and could even stimulate highly relevant humoral and cellular immunological responses. Overall, these results suggest that the designed multi-epitope vaccine can serve as prophylaxis against the yellow fever virus.

Visual evoked potential (VEP) plays a crucial role in the diagnosis of nerve diseases and epilepsy. By applying luminous stimulation in different frequencies, neuronal electrical voltage changes are measured in the visual cortex area at the rear of the head using magnetoencephalogram (MEG). Such acquired MEG signals are separated into components using blind source separation (BSS). The MEG measurements are analyzed by medical experts and, based on their subjective interpretation, the VEP components are identified. Supervised machine learning (ML) methods can be applied to identify VEP components. However, these methods require labeled data, which must be generated through the subjective interpretation of medical experts. This can be limiting as medical experts traditionally assume a fixed amount of components. This paper proposes a blind framework to estimate the model order of the MEG measurements and to extract the VEP components. In order to estimate the amount of components, the framework exploits a low computational complexity modified Akaike Information Criterion (AIC) and does not require human intervention. In order to overcome the need for labeled data, we propose three approaches to automatically compare components extracted from MEG measurements with and without stimulation. Since each proposed unsupervised identification approach identifies a set of VEP components, we propose their decision fusion using set operations. The proposed framework does not require any human intervention, and it can be used as a complementary tool to support experts in identifying VEP components. The results are presented in terms of average amplitude spectrum and spectral topography. The automated procedure employing the combined unsupervised identification approaches is capable of identifying up to five, eight, and seven VEP components at stimulation frequencies of 3.84 Hz, 21.73 Hz, and 19.23 Hz, respectively. Moreover, upon intersecting with the independent components identified through visual inspection, this count decreases to two, four, and two VEP components for the stimulation frequencies 3.84 Hz, 21.73 Hz and 19.23 Hz, respectively. Finally, the calibration parameter of the unsupervised identification approaches can be adapted in order to select a greater or smaller amount of components. The proposed framework is validated using real MEG measurements.

Este estudo examina a adoção do Design Universal para Aprendizagem no ensino de Ciências no Brasil através de uma revisão sistemática de literatura de 2014 a 2023. A análise identificou uma prevalência de publicações no estrato Qualis A3, refletindo um espectro de impacto diversificado. As publicações foram categorizadas em quatro áreas principais: revisões do estado da arte, desenvolvimento de recursos didáticos inclusivos, estudos de caso práticos, e inovação em planejamento de ensino. Os resultados destacam progressos na integração do DUA, mas também a necessidade de mais recursos e estratégias pedagógicas para uma educação mais inclusiva no ensino de Ciências.

This study aimed to evaluate various biomechanical parameters associated with the primary stability of Maestro and Due Cone implants placed in low-density artificial bones, prepared using high-speed drilling with irrigation and low-speed drilling without irrigation. The insertion torque (IT), removal torque (RT), and implant stability quotient (ISQ) values were recorded for Maestro and Due Cone implants placed in low-density polyurethane blocks (10 and 20 pounds per cubic foot (PCF) with and without a cortical layer) prepared using high-speed and low-speed with or without irrigation using a saline solution, respectively. A three-way ANOVA model and Tukey's post-hoc test were conducted, presenting data as means and standard deviations. P-values equal to or less than 0.05 were considered statistically significant. No statistically significant differences in IT, RT, and ISQ between drilling speeds were observed. However, Maestro implants exhibited lower IT and RT values after high- and low-speed drilling across almost all polyurethane blocks, significantly evident in the 20 PCF density block for IT and in the 20 PCF density block with the cortical layer for the RT with low-speed drilling (IT: 47.33 ± 10.02 Ncm and 16.00 ± 12.49 Ncm for Due Cone and Maestro implants, respectively, with p

O acesso ao princípio alfabético pressupõe a aquisição e o desenvolvimento de competências fonológicas, as quais devem ser abordadas os mais precocemente possível, sobretudo em crianças com surdez, devido às suas dificuldades ao nível da linguagem oral. Paralelamente, são necessárias ferramentas de avaliação fiáveis e válidas que permitam aferir a evolução destas crianças, quando submetidas a intervenções que visem o desenvolvimento daquelas competências. Assim, realizou-se uma revisão sistemática da literatura sobre programas de intervenção que tenham visado o desenvolvimento de habilidades fonológicas, em crianças com surdez. A pesquisa para esta revisão iniciou-se com a definição e o encadeamento de palavras e expressões relacionadas com o desenho do estudo, a população e a competência avaliada, que foram inseridas nas bases de dados Scopus, Web of Science, EBSCO, ERIC, ProQuest and Google Scholar. Os procedimentos de triagem, síntese e relato adotados seguiram as diretrizes do PRISMA. Foram incluídos nesta revisão treze estudos publicados em revistas especializadas nas últimas duas décadas, envolvendo um total de 268 crianças com perda auditiva, com idades compreendidas entre os 57 meses e os 15 anos. A maioria dos estudos recorreu a instrumentos estandardizados e validados para a avaliação de competências fonológicas de crianças com desenvolvimento típico da mesma faixa etária e/ou nível de escolaridade. Com exceção de um instrumento, todos os demais analisados tinham como referência de avaliação a norma, assim como a maioria optou por aplicar total ou parcialmente a sua versão original, enquanto dois estudos procederam a adaptações e outros dois criaram os seus próprios instrumentos. A utilização destas ferramentas foi fundamental, para que os profissionais responsáveis pela sua aplicação pudessem, a partir dos seus resultados, delinear métodos, estratégias e recursos que contribuam para um acesso pleno e equitativo destas crianças às formas de comunicação oral e escrita.

Vehicle-to-Everything (V2X) communication, essential for enhancing road safety, driving efficiency, and traffic management, must be robust against cybersecurity threats for successful deployment and acceptance. This survey comprehensively explores V2X security challenges, focusing on prevalent cybersecurity threats such as jamming, spoofing, Distributed Denial of Service (DDoS), and eavesdropping attacks. These threats were selected due to their prevalence and ability to compromise the integrity and reliability of V2X systems. Jamming can disrupt communications, spoofing can lead to data and identity manipulation, DDoS attacks can saturate system resources, and eavesdropping can compromise user privacy and information confidentiality. Addressing these major threats ensures that V2X systems are robust and secure for successful deployment and widespread acceptance. This work makes significant contributions to the field of V2X cybersecurity, starting with a thorough review and categorization of existing survey papers, providing a clear map of the current research landscape, and identifying areas needing further study. An extensive review uncovered a global landscape of V2X cybersecurity research. We highlight contributions from the leading countries in scientific publications and patent innovations, with notable advancements from leading corporations. This work educates and informs on the current state of V2X cybersecurity and identifies emerging trends and future research directions based on a year-by-year analysis of the literature and patents. The findings underscore the evolving cybersecurity landscape in V2X systems and the importance of continued innovation and research in this critical field. The survey navigates the complexities of securing V2X communications, emphasizing the necessity for advanced security protocols and technologies, and highlights innovative approaches within the global scientific and patent research context. By providing a panoramic view of the field, this survey sets the stage for future advancements in V2X cybersecurity.

In this article, a plasmonic gold nanoantenna is proposed as a sensor to monitor refractive index variations between 1.30 and 1.35. These values are defined since they are characteristic of, for instance, water-based solutions, DNA, or haemoglobin. To simulate the device a novel model is used, which takes advantage of the wave-particle dualism and the generalised Fresnel coefficients for absorbing media. Although it is a time-domain model, in this research work the model is improved to compute steady state and frequency-domain results. The response to a Dirac excitation is obtained using that novel model. The steady state is reached for a long pulse emission. The long pulse emission is emulated by a Dirac comb and consequently, the optical response of the device for this kind of excitation is obtained considering the sum of several Dirac's responses shifted in time. Then, steady state might be reached as suggested by the presented results. Taking into account the obtained pulse responses, the refractive index sensor for the range 1.30–1.35 is proposed. The obtained results suggest that 350 nm and 450 nm are the best wavelengths to detect these analyte variations. The sensitivity reaches values up to around 110%/RIU, but sensitivities around 80%/RIU are computed within the range 250–500 nm.

In a Data Science project, it is essential to determine the relevance of the data and identify patterns that contribute to decision–making based on domain–specific knowledge. Furthermore, a clear definition of methodologies and creation of documentation to guide a project’s development from inception to completion are essential elements. This study presents a Data Science model designed to guide the process, covering data collection through training with the aim of facilitating knowledge discovery. Motivated by deficiencies in existing Data Science methodologies, particularly the lack of practical step–by–step guidance on how to prepare data to reach the production phase. Named “Data Refinement Cycle with Supervised Machine Learning (DRC–SML)”, the proposed model was developed based on the emerging needs of a Data Sciense project aimed at assisting healthcare professionals in diagnosing pesticide poisoning among rural workers. The dataset used in this project resulted from scientific research in which 1027 samples were collected, containing data related to toxicity biomarkers and clinical analyses. We achieved an accuracy of 99.61% with only 27 rules for determining the diagnosis. The results optimized healthcare practices and improved quality of life in rural areas. The project outcomes demonstrated the success of the proposed model.

Skull base surgery has evolved remarkably since the pioneering techniques of early 20th-century surgeons, such as Schloffer and Cushing, who laid the foundation for transcranial and transnasal approaches [...]

ABSTRACT Introduction: measuring the severity of traumatic injuries is crucial for predicting clinical outcomes. Whereas the Injury Severity Score (ISS) has limitations in assigning scores to injuries at the same site, the New Injury Severity Score (NISS) corrects for this problem by taking into account the three most severe injuries regardless of the region of the body. This study seeks to comprehend the clinical and epidemiological profile of trauma patients while comparing the effectiveness of scales for predicting mortality. Methods: a descriptive, observational and retrospective study using records of patients who underwent thoracotomy at the Hospital das Clínicas of the Federal University of Triângulo Mineiro between 2000 and 2019. Demographic data, mechanisms of injury, affected organs, length of stay and mortality were analyzed. Injury severity was assessed using the ISS and NISS, and statistical analyses were conducted using MedCalc and SigmaPlot. Results: 101 patients were assessed, on average 29.6 years old, 86.13% of whom were men. The average duration of hospitalization was 10.9 days and the mortality rate was 28.7%. The ROC curve analysis revealed a sensitivity of 68.97%, specificity of 80.56% and area under the curve of 0.837 for the ISS, and 58.62%, 94.44% and 0.855 for the NISS, respectively. The Youden index was 0.49 for the ISS and 0.53 for the NISS. Conclusion: the study demonstrated comparable efficacy of NISS and ISS in predicting mortality. These findings hold significance in the hospital setting. Professionals must be familiar with these scales to utilize them competently for each patient.

Transcription factors are essential regulators of various physiological and pathological processes. However, detecting transcription factor-DNA binding activities is often time-consuming and labor-intensive. Homogeneous biosensors that are compatible with mix-and-measure protocols have the potential to simplify the workflow for therapeutic screening and disease diagnostics. In this study, we apply a combined computational-experimental approach to investigate the design of a sticky-end probe biosensor, where the transcription factor-DNA complex stabilizes the fluorescence resonance energy transfer signal of the donor-acceptor pair. We design a sticky-end biosensor for the SOX9 transcription factor based on the consensus sequence and characterize its sensing performance. A systems biology model is also developed to investigate the reaction kinetics and optimize the operating conditions. Taken together, our study provides a conceptual framework for the design and optimization of sticky-end probe biosensors for homogeneous detection of transcription factor-DNA binding activity.

The effects of methylmercury (MeHg) on exposed populations are a public health problem. In contrast to widely studied neurological damage, few cardiovascular changes have been described. Our group evaluated the cardiotoxicity of a cumulative dose of 70 mg.kg−1 fractioned over a 14-day exposure period in mice (MeHg70 group). The effects of MeHg on proteins relevant to cardiac mitochondrial function were also investigated. The results obtained showed a reduction in oxygen consumption in the two settings. In cardiac tissue samples in oxygraphy studies, this reduction was related to a lower efficiency of complexes II and V, which belong to the oxidative phosphorylation system. In vivo, mice in the MeHg70 group presented lower oxygen consumption and running tolerance, as shown by ergometric analyses. Cardiac stress was evident in the MeHg70 group, as indicated by a marked increase in the level of the mRNA encoding atrial natriuretic peptide. Electrocardiogram studies revealed a lower heart rate at rest in the animals from the MeHg70 group, as well as prolonged left ventricular depolarisation and repolarisation. Through echocardiographic analysis, reductions in the left ventricular ejection fraction and left ventricular wall thickness of approximately 10% and 20%, respectively, were detected. These results indicate that the oral intake of MeHg can decrease cardiac function and oxidative metabolism. This finding highlights the importance of monitoring MeHg levels in humans and animals in contaminated areas, as well as periodically carrying out cardiac function tests.

Background: Clostridioides difficile infection (CDI) represents a prevalent and potentially severe health concern linked to the usage of broad-spectrum antibiotics. The aim of this study was to evaluate a new lyophilized product based on human fecal microbiota for transplant, including cost–benefit analysis in the treatment of recurrent or refractory CDI. Methods: The product for fecal microbiota transplant was obtained from two donors. Microbiological, viability, and genomic analysis were evaluated. After validation, a clinical pilot study including recurrent or refractory CDI with 24 patients was performed. Clinical response and 4-week recurrence were the outcome. Cost–benefit analysis compared the fecal microbiota transplant with conventional retreatment with vancomycin or metronidazole. Results: The microbiota for transplant presented significant bacterial viability, with and adequate balance of Firmicutes and Bacteroidetes. The clinical response with the microbiota transplant was 92%. In financial terms, estimated expenditure for CDI solely related to recurrence, based on stochastic modeling, totals USD 222.8 million per year in Brazil. Conclusions: The lyophilized human fecal microbiota for transplant is safe and can be an important step for a new product with low cost, even with genomic sequencing. Fecal microbiota transplantation emerges as a more cost-effective alternative compared to antimicrobials in the retreatment of CDI.

Increasing soybean productivity can be achieved by treating seeds with biostimulants. To this end, an investigation was conducted into the potential of a formulation prepared with clove es-sential oil (CEO) diluted in soybean oil for seed treatment. Soybean seeds were treated with CEO concentrations between 0.5 to 3.0 mL/L, and subjected to germination, vigor, and sanity analyses. The CEO at 1.6 mL/L exhibited favorable outcomes regarding germination, root length, and re-duced fungal infection. In this way, a two-crop field experiment evaluated soybean seeds treated with CEO at 1.6 mL/L. Soybean seeds treated with CEO in the field in 2021/2022 were not different from the controls. However, in 2019/2020, there was a higher percentage of emergence, nodulation, and production of 749 kg/ha more than in the industrial treatment. These results highlight the potential use of CEO as a biostimulant.

Abstract Functional pituitary adenomas (FPAs) are associated with hormonal hypersecretion resulting in systemic endocrinopathies and increased mortality. The heterogenous composition of the FPA population has made modeling predictive factors of postoperative disease remission a challenge. Here, we aim to define a novel scoring system predictive of disease remission following transsphenoidal surgery (TSS) for FPAs and validate our process using supervised machine learning (SML). 392 patients with FPAs treated at one of the three Mayo Clinic campuses were retrospectively reviewed. Variables found significant on multivariate analysis were incorporated into our novel Pit-SCHEME score. The Pit-SCHEME score with a cut-off value ≥ 6 achieved a sensitivity of 86% and positive likelihood ratio of 2.88. In SML models, without the Pit-SCHEME score, the k-nearest neighbor (KNN) model achieved the highest accuracy at 75.6%. An increase in model sensitivity was achieved with inclusion of the Pit-SCHEME score with the linear discriminant analysis (LDA) model achieving an accuracy of 86.9%, which suggests the Pit-SCHEME score is the variable of most importance for prediction of postoperative disease remission. Ultimately, these results support the potential clinical utility of the Pit-SCHEME score and its prospective future for aiding in the perioperative decision making in patients with FPAs.

The 24th annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Richmond, British Columbia, on 28–29 October 2022. The WCGCCC is an interactive multidisciplinary conference attended by healthcare professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals such as dieticians, nurses and a genetic counsellor participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancer.

Abstract Intestinal P‐glycoprotein (P‐gp) activity plays a crucial role in modulating the oral bioavailability of its substrates. Fexofenadine has commonly been used as a P‐gp probe, although it is important to note the involvement of other drug transporters like, OATP1B1, OATP1B3, and OATP2B1. In vitro studies demonstrated an upregulation of P‐gp protein in response to exposure to pregnancy‐related hormones. The objective of this study was to investigate how intestinal P‐gp activity is impacted by menopausal status. This study sampled fexofenadine plasma concentrations over 0–12 h after probe drug administration from two groups of patients with breast cancer: premenopausal (n = 20) and postmenopausal (n = 20). Fexofenadine plasma concentrations were quantified using liquid‐chromatography tandem mass spectrometry. Area under the plasma concentration‐time curve from zero to infinity (AUCinf) was calculated through limited sampling strategies equation. Multiple linear regression was applied on AUCinf, maximum plasma concentration (Cmax), and time to Cmax. Postmenopausal patients showed a significant increase in Cmax (geometric mean and 95% confidence interval [CI] 143.54, 110.95–176.13 vs. 223.54 ng/mL, 161.02–286.06 and in AUCinf 685.55, 534.98–878.50 vs. 933.54 ng·h/mL 735.45–1184.99) compared to premenopausal patients. The carriers of the ABCB1 3435 allele T displayed higher Cmax values of 166.59 (95% CI: 129.44–214.39) compared to the wild type at 147.47 ng/mL (95% CI: 111.91–194.34, p = 0.02). In postmenopausal individuals, the decrease in P‐gp activity of ~40% may lead to an increased plasma exposure of orally administered P‐gp substrates.

Because progesterone (P4) is essential for pregnancy establishment and maintenance, we investigated the effect of increased concentrations of P4 on embryonic attachment and concentrations of pregnancy-associated glycoproteins (PAG). Additionally, we investigated the relationships among luteal regression, pregnancy loss, and PAG concentrations in cows undergoing pregnancy loss by d 33 of pregnancy. Lactating dairy cows were allocated into control (n = 40) and human chorionic gonadotropin (hCG; 3,300 IU on d 7 and 13 to promote greater circulating P4; GnRH = d 0; n = 46) groups. Progesterone was measured daily from d 7 to 33, and PAG was measured daily from d 17 to 33; both hormones were also measured on d 47 and 61. An increase in PAG >10% compared with d 17 was considered a marker for pregnancy. The gold standard for pregnancy diagnosis was ultrasound evaluation of embryonic heartbeat on d 33. Statistical analyses were done with PROC MIXED from SAS Institute Inc. Concentrations of P4 were greater from d 8 onward in the hCG group. Concentrations of PAG did not differ between groups from d 17 to 33, suggesting no effect of increased P4 on hastening embryonic attachment and placental development. Nevertheless, PAG was greater in the hCG group on d 47 and 61, suggesting greater placental area or PAG secretory capacity. Pregnancy loss between d 20 and 33 occurred in 24.6% of cows. About 50% of pregnancy loss was due to luteal regression and about 50% was due to conceptus failure; that is, a decrease in PAG in the absence of luteal regression. In conclusion, increased P4 does not hasten embryonic attachment or early placental development but it leads to increased PAG in the second half of the second month of gestation. Additionally, pregnancy loss seems to be initiated by either corpus luteum regression or conceptus failure.

Cultivated meat (CM) is a disruptive technology that provides an alternative to animal protein. In this context, the Amazon manatee (Trichechus inunguis) emerges as an important case. Although it is illegal to hunt this large mammal, its meat continues to be consumed, causing several threats to its natural habitat. The aim of this study is to explore the impacts of introducing the Amazon manatee CM into the traditional meat value chain as a tool to aid the biodiversity of the Amazon Basin. Thus, we developed a strengths, weaknesses, opportunities, and threats matrix from the content analysis of 11 interviews conducted between October 2021 and May 2022. The interviewees were experts in different fields, ranging from financial analysts of novel food technologies to biologists, researchers, and others. We presented the theme of illegal hunting and its consequences during the interviews, followed by the CM process, and explained how the royalties from the sale of this innovative product could help to preserve Amazon biodiversity through the proposal of a new business model. The main findings suggest that the proposed model would produce good results, but the threat of a rebound effect from the consumption of wild animals was mentioned in most responses, especially by actors involved in conservation. The strengths and opportunities of this disruptive narrative mainly focused on preserving biodiversity and promoting environmental awareness, combining the conservation of wildlife and the consumption of novel food. The weaknesses included the lack of knowledge and the non-existent market. This framework is relevant for policymakers, nongovernmental organizations, and researchers seeking to improve the sustainability not only of the species found in the Amazon, but also around the world.

Abstract Introduction Pseudomonas aeruginosa respiratory infections are challenging, and the risk of recurrence is a frequent problem. The aim of this study was to investigate the risk factors associated with the presence of P. aeruginosa, and the risk factors related to the recurrence and death of lower airway infections in inpatients in a Brazilian hospital. Methods Retrospective cohort with inpatients that had a sample of airways culture (tracheal aspirate or bronchoalveolar lavage) with the detection of P. aeruginosa. The patients with clinical criteria of infection were classified as ventilator‐associated, hospital‐acquired, or community‐acquired pneumonia. P. aeruginosa in respiratory samples without symptoms was considered colonization. The antimicrobial treatment adequacy and the clinical data were evaluated. Outcome variables included mortality and recurrence. Results One hundred and fifty‐four patients were included in the study, most of them were men, and the majority (102) were considered infected. The average length of stay was superior to 30 days. Previous pulmonary disease was associated with the occurrence of colonization. Aminoglycosides were the most active drug according to susceptibility tests and were successfully used as monotherapy. Septic shock was a risk factor for death in the infected patients. The use of adequate antimicrobial therapy was associated with major survival, independent of the infection classification. Conclusion It is possible to evaluate clinical data associated with recurrence and mortality in patients with different lung infections by P. aeruginosa. Aminoglycoside monotherapy is safe and effective in P. aeruginosa respiratory infections.

Karen Mulder was not included as an author in the original publication [...]

Category: Lesser Toes; Trauma Introduction/Purpose: Because lateral toes are anatomically on the distal aspect of foot, they are more exposed to axial load (stubbed toe) and crushing injuries. In this context, correct obtainment of imaging exams is fundamental for proper diagnosis of MSI. In the X-ray room, however, due to overlapping of smaller fingers or because the patient`s pain, most common practice is to suppress the lateral view. The purpose of this study is to demonstrate the importance of toe radiographs in diagnosis of interphalangeal fractures and dislocations, emphasizing need for lateral view for diagnosis of these injuries. Methods: 378 radiographs of 126 patients treated between Jan/2018 and Mar/2018 in an emergency care clinic of a Brazilian hospital were retrospectively evaluated for presence of fractures. Patients were selected from a search on medical records using ICD. After, the radiographs of the same patient were duplicated and divided in two groups: standard group (AP and Oblique) and complete profile group (standard views plus lateral view). They were examined by four independent examiners of different degrees of experience. Each examiner randomly evaluated the same patient twice (1 in each group). Kappa index was used to evaluate intra and inter-examiner concordance, and the two-proportion equality test was used to calculate statistical significance. Results: Mean age of patients was 37,2 years (4-85yr). 144 fractures were diagnosed in standard group (28,6%) and 266 fractures (52,8%) in complete profile group (p < 0,001). Individually evaluating each examiner, everyone had had an improvement in number of fracture diagnostics when compared the complete profile group with the other (p < 0,001). Kappa index was superior to 0,60 for all examiners in pattern group. Conclusion: Addition of true lateral view was able to improve the number of diagnosed fractures on patients with lesser toes trauma.

Introduction Pathological processes in the arterial wall that result in vessel dilation are the cause of intracranial aneurysms (IAs), and the risk factors for their formation and progression are not well established. Ferritin is associated with inflammation and angiogenesis; it has protective antioxidative activity, and controls cell differentiation. Vitamin B12 is related to neurological and hematological disorders; it can be used as differential diagnosis tool, and acts in the control of homocysteinemia, a predictor of worse prognosis. The present article aims to assess the correlation between serum ferritin and B12 levels and the patient's functional outcome.

The performance of paracanoistsis characterized by the ability of the athlete to advance at maximum speed, through a technically optimal paddling motion. It`s important to consider that in the case of para-athletes, the application of forces towards paddling is compromised by physical deficiencies. Thus, this study aims to assess the performance of athletes in the KL1, KL2 and KL3 sport classes, during a paralympicparacanoe event. The sample was composed of athletes from the Brazilian male paracanoe team, with a representative of each sport class: KL1, KL2, KL3 For performance analysis, we used a kayak ergometer (KayakPro®, Miami Beach, FL, USA) to simulate a 200-meter trial, during Rio 2016 Paralympic Games Road. The variables were evaluated: time trial, stroke frequency, mean speed, number of strokes, stroke length, stroke index, and power. According to results: I) the athlete KL3 had the lowest number of strokes, the longest stroke length and the highest stroke rate index; II) the athlete KL1 had the highest number of strokes, the lowest stroke length and the stroke rate index. This study puts into perspective the distinct characteristics of a paracanoe trial, analyzed in consideration to each sport class.

Machine learning algorithms present a robust alternative for building Intrusion Detection Systems due to their ability to recognize attacks in computer network traffic by recognizing patterns in large amounts of data. Typically, classifiers are trained for this task. Together, ensemble learning algorithms have increased the performance of these detectors, reducing classification errors and allowing computer networks to be more protected. This research presents a comprehensive Systematic Review of the Literature where works related to intrusion detection with ensemble learning were obtained from the most relevant scientific bases. We offer 188 works, several compilations of datasets, classifiers, and ensemble algorithms, and document the experiments that stood out in their performance. A characteristic of this research is its originality. We found two surveys in the literature specifically focusing on the relationship between ensemble techniques and intrusion detection. We present for the last eight years covered by this survey a timeline-based view of the works studied to highlight evolutions and trends. The results obtained by our survey show a growing area, with excellent results in detecting attacks but with needs for improvement in pruning for choosing classifiers, which makes this work unprecedented for this context.

We present DIO, a generic tool for observing inefficient and erroneous I/O interactions between applications and in-kernel storage backends that lead to performance, dependability, and correctness issues. DIO eases the analysis and enables near real-time visualization of complex I/O patterns for data-intensive applications generating millions of storage requests. This is achieved by non-intrusively intercepting system calls, enriching collected data with relevant context, and providing timely analysis and visualization for traced events. We demonstrate its usefulness by analyzing four production-level applications. Results show that DIO enables diagnosing inefficient I/O patterns that lead to poor application performance, unexpected and redundant I/O calls caused by high-level libraries, resource contention in multithreaded I/O that leads to high tail latency, and erroneous file accesses that cause data loss. Moreover, through a detailed evaluation, we show that, when comparing DIO’s inline diagnosis pipeline with a similar state-of-the-art solution, our system captures up to $28{x}$ more events while keeping tracing performance overhead between 14% and 51%.

Abstract The WHO ACTION-I trial, the largest placebo-controlled trial on antenatal corticosteroids (ACS) efficacy and safety to date, reaffirmed the benefits of ACS on mortality reduction among early preterm newborns in low-income settings. We discuss here lessons learned from ACTION-I trial that are relevant to a strategy for ACS implementation to optimize impact. Key elements included (i) gestational age dating by ultrasound (ii) application of appropriate selection criteria by trained obstetric physicians to identify women with a likelihood of preterm birth for ACS administration; and (iii) provision of a minimum package of care for preterm newborns in facilities. This strategy accurately identified a large proportion of women who eventually gave birth preterm, and resulted in a 16% reduction in neonatal mortality from ACS use. Policy-makers, programme managers and clinicians are encouraged to consider this implementation strategy to effectively scale and harness the benefits of ACS in saving preterm newborn lives.

Abstract Background Governments in Latin America are constantly facing the problem of managing scarce resources to satisfy alternative needs, such as housing, education, food, and healthcare security. Those needs, combined with increasing crime levels, require financial resources to be solved. Objective The objective of this review was to characterizar the health system and health expenditure of a large country (Brazil) and a small country (Chile) and identify some of the challenges these two countries face in improving the health services of their population. Methods A literature review was conducted by searching journals, databases, and other electronic resources to identify articles and research publications describing health systems in Brazil and Chile. Results The review showed that the economic restriction and the economic cycle have an impact on the funding of the public health system. This result was true for the Brazilian health system after 2016, despite the change to a unique health system one decade earlier. In the case of Chile, there are different positions about which one is the best health system: a dual public and private or just public one. As a result, a referendum on September 4, 2022, of a new constitution, which incorporated a unique health system, was rejected. At the same time, the Government ended the copayment in the public health system in September 2022, excluding illnesses referred to the private sector. Another issue detected was the fragility of the public and private sector coverage due to the lack of funding. Conclusions The health care system in Chile and Brazil has improved in the last decades. However, the public healthcare systems still need additional funding and efficiency improvement to respond to the growing health requirements needed from the population.

The strain-induced crystallization and elastocaloric properties of various natural rubber (NR)/ground tire rubber (GTR) blends, comprising waste particles of diverse sizes and contents, were investigated. The decreasing inter-distance between particles in conjunction with their increasing content as studied by micro-computed tomography (μCT) as well as the inter-melling between GTR and NR matrix were observed. It resulted in a strain localization in the NR matrix at the GTR and NR interface at the origin of mechanical reinforcement upon tensile deformation. In addition, GTR particles were found to show a nucleating ability on strain-induced crystallization (SIC) and elastocaloric properties independently of the particle size. The strain localization was found to relate to a localization of the temperature field, suggesting localization of the elastocaloric effect in NR/GTR blends. The evidence of such heterogeneities would be of interest for the proper design of elastocaloric waste-based rubber composites for heating/cooling applications.

It has been suggested that sex distinctions in physiology may affect the swimming performance of each sex differently. Yet, sex-based performance dependency has not been taken into consideration by most of the researchers evaluating swimming start. Therefore, the purpose of this research was to determine the effect of sex heterogeneity on the spatiotemporal characteristics of swimming start by investigating the determinants of its performance. A total of fifty-two international-level swimmers (thirty females and twenty-two males) performed three repetitions of the kick-start up to the 15-m mark. During trials, data were collected using video cameras and instrumented starting block. To search for evidence of differences between the two groups, the one-way ANOVA was conducted. Pearson’s correlation coefficients were calculated between measurements widely used to describe overall starting performance and selected kinematical variables of swimming start. A sex effect was exposed for temporal variables describing all swimming start phases (p ≤ 0.015). Male swimmers, by spending less time during the push-off from the starting block (p = 0.002; ηp2 = 0.18), reaching higher take-off velocity (p < 0.001; ηp2 = 0.29), traveling longer distances during flight (p < 0.001; ηp2 = 0.40), and swimming faster in the water phase (p < 0.001; ηp2 = 0.40), took starting advantage over their female counterparts. Consequently, performance measures such as 5-m, 10-m, and 15-m start times indicated that male participants were faster than females (p < 0.001; ηp2 ≥ 0.40). Only in the group of male swimmers a significant correlation between variables describing overall starting performance (5-m, 10-m, and 15-m times), and variables commonly highlighted as starting performance determining factors (block phase duration, take-off horizontal velocity, and flight distance) was found. The current study shows that the spatiotemporal variables of swimming start, the relation between them as well as overall starting performance, vary by sex. Consequently, the requirement of sex factor and its heterogeneity effect should be included not only in detailed characteristics of separate variables but also in all approaches undertaken. Those findings seem to play a crucial role mainly in swimming start evaluations in post-pubertal age groups of swimmers.

Abstract Physical activity comprises four domains (leisure, transportation, domestic, and work activities) that may be differently associated with oral health. The aim of this study was to assess the association between each physical activity domain and oral health conditions in Brazilian adults. A total of 38,539 participants in the 2019 Brazilian Health Survey aged 30 years or older were analyzed. The outcomes were self-perceived oral health (dichotomous) and self-reported number of missing teeth (counts). The presence, frequency, and time of activity in each domain and their combination were analyzed as main exposures. Odds ratios (OR) and mean ratios (MR) were estimated by fitting multivariable models. Higher leisure time physical activity was the only domain associated with better self-perception of oral health (OR = 1.32; 95%CI 1.26–1.38) and lower tooth loss (MR=0.88; 95%CI 0.86–0.90). Higher levels of work, transportation, and household activities were significantly associated with worse self-perception of oral health, while higher levels of work– and transportation–related physical activities were also associated with greater tooth loss. When the total recommended weekly physical activity time was analyzed, no significant associations were found. Sensitivity analysis suggested that this pattern persists in potential periodontitis–related cases, such as when selecting older age or excluding individuals with no tooth loss. In conclusion, leisure physical activity was the only domain with the potential of reflecting the benefits of physical activity on oral health. The inclusion of other domains can confound this association.

Information on a crop’s three-dimensional (3D) structure is important for plant phenotyping and precision agriculture (PA). Currently, light detection and ranging (LiDAR) has been proven to be the most effective tool for crop 3D characterization in constrained, e.g., indoor environments, using terrestrial laser scanners (TLSs). In recent years, affordable laser scanners onboard unmanned aerial systems (UASs) have been available for commercial applications. UAS laser scanners (ULSs) have recently been introduced, and their operational procedures are not well investigated particularly in an agricultural context for multi-temporal point clouds. To acquire seamless quality point clouds, ULS operational parameter assessment, e.g., flight altitude, pulse repetition rate (PRR), and the number of return laser echoes, becomes a non-trivial concern. This article therefore aims to investigate DJI Zenmuse L1 operational practices in an agricultural context using traditional point density, and multi-temporal canopy height modeling (CHM) techniques, in comparison with more advanced simulated full waveform (WF) analysis. Several pre-designed ULS flights were conducted over an experimental research site in Fargo, North Dakota, USA, on three dates. The flight altitudes varied from 50 m to 60 m above ground level (AGL) along with scanning modes, e.g., repetitive/non-repetitive, frequency modes 160/250 kHz, return echo modes (1n), (2n), and (3n), were assessed over diverse crop environments, e.g., dry corn, green corn, sunflower, soybean, and sugar beet, near to harvest yet with changing phenological stages. Our results showed that the return echo mode (2n) captures the canopy height better than the (1n) and (3n) modes, whereas (1n) provides the highest canopy penetration at 250 kHz compared with 160 kHz. Overall, the multi-temporal CHM heights were well correlated with the in situ height measurements with an R2 (0.99–1.00) and root mean square error (RMSE) of (0.04–0.09) m. Among all the crops, the multi-temporal CHM of the soybeans showed the lowest height correlation with the R2 (0.59–0.75) and RMSE (0.05–0.07) m. We showed that the weaker height correlation for the soybeans occurred due to the selective height underestimation of short crops influenced by crop phonologies. The results explained that the return echo mode, PRR, flight altitude, and multi-temporal CHM analysis were unable to completely decipher the ULS operational practices and phenological impact on acquired point clouds. For the first time in an agricultural context, we investigated and showed that crop phenology has a meaningful impact on acquired multi-temporal ULS point clouds compared with ULS operational practices revealed by WF analyses. Nonetheless, the present study established a state-of-the-art benchmark framework for ULS operational parameter optimization and 3D crop characterization using ULS multi-temporal simulated WF datasets.

Abstract Chromosomal microarray analysis (CMA) has been recommended and practiced routinely since 2010 both in the USA and Europe as the first-tier cytogenetic test for patients with unexplained neurodevelopmental delay/intellectual disability, autism spectrum disorders, and/or multiple congenital anomalies. However, in Brazil, the use of CMA is still limited, due to its high cost and complexity in integrating the results from both the private and public health systems. Although Brazil has one of the world’s largest single-payer public healthcare systems, nearly all patients referred for CMA come from the private sector, resulting in only a small number of CMA studies in Brazilian cohorts. To date, this study is by far the largest Brazilian cohort (n = 5788) studied by CMA and is derived from a joint collaboration formed by the University of São Paulo and three private genetic diagnostic centers to investigate the genetic bases of neurodevelopmental disorders and congenital abnormalities. We identified 2,279 clinically relevant CNVs in 1886 patients, not including the 26 cases of UPD found. Among detected CNVs, the corresponding frequency of each category was 55.6% Pathogenic, 4.4% Likely Pathogenic and 40% VUS. The diagnostic yield, by taking into account Pathogenic, Likely Pathogenic and UPDs, was 19.7%. Since the rational for the classification is mostly based on Mendelian or highly penetrant variants, it was not surprising that a second event was detected in 26% of those cases of predisposition syndromes. Although it is common practice to investigate the inheritance of VUS in most laboratories around the world to determine the inheritance of the variant, our results indicate an extremely low cost–benefit of this approach, and strongly suggest that in cases of a limited budget, investigation of the parents of VUS carriers using CMA should not be prioritized.

Antisperm antibodies (ASA), as a cause of male infertility, have been detected in infertile males as early as 1954. Multiple causes of ASA production have been identified, and they are due to an abnormal exposure of mature germ cells to the im-mune system. ASA testing (with mixed anti-globulin reaction, and immunobead binding test) was described in the WHO manual 5th edition and is most recently listed among the extended semen tests in the WHO manual 6th edition. The relation-ship between ASA and infertility is somewhat complex. The presence of sperm agglutination, while insufficient to diagnose immunological infertility, may indicate the presence of ASA. However, ASA can also be present in the absence of any sperm agglutination. The andrological management of ASA depends on the etiology and individual practices of clinicians. In this ar-ticle, we provide a comprehensive review of the causes of ASA production, its role in immunological male infertility, clinical indications of ASA testing, and the available therapeutic options. We also provide the details of laboratory procedures for as-sessment of ASA together with important measures for quality control. Additionally, laboratory and clinical scenarios are pre-sented to guide the reader in the management of ASA and immunological male infertility. Furthermore, we report the results of a recent worldwide survey, conducted to gather information about clinical practices in the management of immunological male infertility.

Purpose:Purpose: The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy se-men analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. Materials and Methods:Materials and Methods: We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory sce-narios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic’s Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. Results:Results: Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unpro-tected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the major-ity of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA’s. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. Conclusions:Conclusions: Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compli-ance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.

The limited preservation duration of donor organs is a big problem. Here the authors report a method for the freezing of whole rat livers at temperatures between −10 °C to −15 °C for up to 5 days, based on freeze-tolerant wood frogs, and term this partial freezing.

In the cotton crop (Gossypium hirsutum L.), there is a complexity of pests that appear systematically, thus significantly reducing crop yield; and their population fluctuation is strongly influenced by meteorological conditions that result in a greater or lesser density of these insects. Thus, this work aimed to evaluate the population fluctuation of insect pests with sucking feeding behavior in an area with and without irrigation in the cotton plant under second-harvest conditions. The experiment was developed at the State University of Maringá - Campus of Umuarama. In the experimental area, grid meshes of 10 × 10 m were demarcated, forming plots of 100 m², resulting in a total of 64 points in the irrigated area and 42 points in the non-irrigated area. The sampling points were demarcated in the center of each grid where three randomly selected plants were sampled. Samplings were carried out weekly, from 37 to 122 days after the emergence (DAE) of cotton, examining the aerial part of the plant, to observe the presence of aphids (Aphis gossypii), thrips (Frankliniella schultzei), and whitefly (Bemisia tabaci). The non-irrigated area provided the highest population peaks of whiteflies and thrips. On the other hand, the irrigated area had a higher incidence of aphids. However, with the increase in the population of ladybugs, the incidence of pests reduced significantly, showing the efficiency and importance of the control carried out by natural predators.

Objective: Determine the prevalence of accessory muscles around the ankle of patients with ankle pain using magnetic resonance imaging (MRI) and evaluate its correlation with other foot and ankle disorders. In addition, better understand the association with accessory muscle and types of pain, mechanical due to compression forces around ankle structures or neuropathic due to mass effect around the tarsal tunnel. Methods: The MRIs obtained from 2007 to 2017 were retrospectively studied and analyzed by a radiologist specializing in foot and ankle pathologies. A total of 9,600 scans were studied after ankle pain; 31 scans had at least one accessory muscle. Results: The prevalence of symptomatic accessory muscle was 0.32% (31 feet). It was found due to mechanical pain in 45.2% of cases. It was considered an incidental finding in 32.3%. Tarsal syndrome was the main clinical presentation in 19.4%, and 16% had other causes of mechanical disorders: 10% with peroneal tendinitis, 3% with Achilles tendinopathy, and 3% with plantar fasciitis. The prevalence of accessory muscles was 35% of the flexor digitorum, 32% of the peroneus quartus, 19% of the fibulocalcaneus internus, 13% of the accessory soleus, and 6% of the tibiocalcaneus internus. Conclusion: Although rare, accessory muscles can contribute to ankle pain with various presentations that confound clinical diagnosis or even appear as incidental on MRI and should be considered in the management of ankle pain. Level of Evidence III; Therapeutic Studies; Retrospective cohort study.

Nano antennas have a significant role in photonic nanodevices due to the ability of concentrating radiation in a small space region. The confined fields present a high sensitivity to the used materials in that regions. The electromagnetic wave models of nanoantennas usually operate in the frequency domain. However, electromagnetic wave models in the time domain are just as important and more advantageous, for example, in light pulses propagation. In this article, a new stochastic method based on the ray model of light in absorbing media is presented and light patterns on a target near a nanoantenna are obtained. The optical properties of the materials are described by their complex refractive index. When dealing with photons in the time domain, this formulation allows the calculation of the probability of a given photon movement. Different patterns, obtained with the new method, are compared with a Finite Element Tool ones, leading to model validation. The simulated structure included an aperture nanoantenna. With this method, the results show the light confinement and the extraordinary optical transmission phenomenon, meaning some photons on the target are refracted and re-transmitted by the metal. Thus, the output beam is more intense than the transmitted directly by the apertures.

At nano-scale new phenomena have been discovered, allowing devices’ miniaturisation, energy harvesting, and power reduction. The Extraordinary Optical Transmission (EOT) phenomenon was reported in 1998 by Ebessen, who stated that the resonant peaks in the response of metallic nano antennas were more intense than predicted by classical diffraction theories. Years later, the main reason for this behaviour was attributed to the Surface Plasmon Polaritons (SPP), at least in ultraviolet and visible regions. In this article, a new method to model the radiation-matter interaction on a dielectric-metal interface is proposed, based on Maxwell’s equations and Fresnel Coefficients in absorbing media. Transmission percentage, angle and propagation length are obtained for a rigorous sweep on incident angle and wavelength. The results taken using some noble metals allow us to observe the presence of surface phenomena at expected SPP resonances. First, it is noticeable huge values of transmission in ultraviolet and visible regions, meaning that the metal does not reflect all the radiation. Also, the transmission angle tends to be higher, meaning huge surface components. Furthermore, the transmission length is on orders of 50-100 nm, meaning that phenomena as EOT only occurs at the nano-scale, since waves should arrive at another interface before being absorbed.

Managing and evolving a chatbot’s content is a laborious process and there is still a lack of standardization. In this context of standardization, the absence of a management process can lead to bad user experiences with a chatbot. This work proposes the Chatbot Management Process, a methodology for content management on chatbot systems. The proposed methodology is based on the experiences acquired with the development of Evatalk, the chatbot for the Brazilian Virtual School of Government. The focus of this methodology is to evolve the chatbot content through the analysis of user interactions, allowing a cyclic and human-supervised process. We divided the proposed methodology into three distinct phases, namely, manage, build, and analyze. Moreover, the proposed methodology presents a clear definition of the roles of the chatbot team. We validate the proposed methodology along with the creation of the Evatalk chatbot, whose amount of interactions was of 22,771 for the 1,698,957 enrolled attendees in the Brazillian Virtual School of Government in 2020. The application of the methodology on Evatalk’s chatbot brought positive results: we reduced the chatbot’s human hand-off rate from 44.43% to 30.16%, the chatbot’s knowledge base examples increased by 160% whilst maintaining a high percentage of confidence in its responses and keeping the user satisfaction collected in conversations stable.

Fault-tolerance methods are required to ensure high availability and high reliability in cloud computing environments. In this survey, we address fault-tolerance in the scope of cloud computing. Recently, cloud computing-based environments have presented new challenges to support fault-tolerance and opened new paths to develop novel strategies, architectures, and standards. We provide a detailed background of cloud computing to establish a comprehensive understanding of the subject, from basic to advanced. We then highlight fault-tolerance components and system-level metrics and identify the needs and applications of fault-tolerance in cloud computing. Furthermore, we discuss state-of-the-art proactive and reactive approaches to cloud computing fault-tolerance. We further structure and discuss current research efforts on cloud computing fault-tolerance architectures and frameworks. Finally, we conclude by enumerating future research directions specific to cloud computing fault-tolerance development.

Human language is naturally fuzzy by nature, with words meaning different things to different people, depending on the context. Fuzzy words, are words with a subjective meaning, typically used in everyday human natural language dialogue; they are often ambiguous and vague in meaning depending on an individual’s perception. Fuzzy Sentence Similarity Measures (FSSM) are algorithms that can compare two or more short texts which contain fuzzy words and return a numeric measure of similarity of meaning between them. This paper proposes a new FSSM called FUSE (FUzzy Similarity mEasure). FUSE is an ontology-based similarity measure that uses Interval Type-2 Fuzzy Sets to model relationships between categories of human perception-based words. The FUSE algorithm has been developed over four versions and been compared to several state-of-the-art, traditional semantic similarity measures (SSM’s) which do not consider the presence of fuzzy words. The FUSE algorithm along with the other traditional SSM’s mentioned have been evaluated on several published, gold standard and newly created datasets. Results have shown the FUSE algorithm is able to improve on the limitations of traditional SSM’s by achieving a higher correlation with the average human rating (AHR) compared to traditional SSM’s that do not consider the presence of fuzzy words. The key contributions of this work can be summarised as follows: The development of a new methodology to model fuzzy words using Interval Type-2 fuzzy sets. This has led to the creation of a fuzzy dictionary for nine fuzzy categories, a useful resource which can be used by other researchers in the field of natural language processing and Computing with Words (CWW) with other fuzzy applications such as semantic clustering.

The rapid urbanization process in the last century has deeply changed the way we live and interact with each other. As most people now live in urban areas, cities are experiencing growing demands for more efficient and sustainable public services that may improve the perceived quality of life, specially with the anticipated impacts of climatic changes. In this already complex scenario with increasingly overcrowded urban areas, different types of emergency situations may happen anywhere and anytime, with unpredictable costs in human lives and economic losses. In order to cope with unexpected and potentially dangerous emergencies, smart cities initiatives have been developed in different cities, addressing multiple aspects of emergencies detection, alerting, and mitigation. In this context, this article surveys recent smart city solutions for crisis management, proposing definitions for emergencies-oriented systems and classifying them according to the employed technologies and provided services. Additionally, recent developments in the domains of Internet of Things, Artificial Intelligence and Big Data are also highlighted when associated to the management of urban emergencies, potentially paving the way for new developments while classifying and organizing them according to different criteria. Finally, open research challenges will be identified, indicating promising trends and research directions for the coming years.

ABSTRACT Objective: To examine and compare the clinical efficacy of intraarticular epsilon aminocaproic acid (EACA) and tranexamic acid (TXA) in total knee arthroplasty (TKA). Methods: This study was a prospective, single-center, double-blinded randomized controlled trial, including sixty patients with osteoarthritis of the knee divided into two groups of 30 patients. In the TXA group, 1 g of TXA (0.05 g/ml) was applied intraarticularly, and in the EACA group, 4 g of EACA (0.2 g/ml) was applied intraarticularly. Serum hemoglobin (Hgb) and hematocrit (Htb) were measured during the preoperatively and 24 and 48 hours postoperatively. The range of motion and pain were evaluated by clinical examination. To evaluate knee function before and 2 months after surgery, the Western Ontario and McMaster Universities Index (WOMAC) questionnaire was used. Results: In total, 56 (93.3%) patients were evaluated up to the second postoperative month. No significant difference between the groups (p > 0.05) was found in the decrease in Hgb or Htb at 24 or 48 hours. Regarding assessment of the pain, WOMAC score and gain in knee flexion, no significant advantages up to 60 days after surgery (p > 0.05) were found. Conclusions: The decrease in Hgb and Htb during the first 48 hours postoperatively and the risk of transfusion were similar with the intraarticular use of 1 g of TXA and 4 g of EACA in TKA. The possible benefits regarding knee pain, gain in flexion and function were also similar for the two drugs. Level of Evidence II, Randomized, Double-Blinded, Single-Centre, Prospective Clinical Trial.

Liquid biopsies are the detection of molecular information in fluids from patients with cancer. In colorectal cancer (CRC), the most promising liquid biopsy strategy is the use of circulating tumor DNA (ctDNA) from plasma. In early-stage CRC, the potential for ctDNA to impact care stems from the detection of minimal residual disease (MRD) to guide adjuvant therapy after curative intent treatment and in identifying recurrences during surveillance. As for any new diagnostic test, ctDNA assays must overcome pre-analytical and analytical challenges before clinical implementation. We will discuss important logistical and assay considerations that clinicians and patients should understand when assessing ctDNA assays. We will also delve into important concepts to aid in interpreting ctDNA results and potential incidental findings that may arise. Sequencing errors, germline variants, and clonal hematopoiesis of indeterminate potential (CHIP) must be addressed to properly interpret results. CHIP is also an important consideration that impacts patient prognosis through association with cardiovascular and hematologic diseases. With this background in place, we next review the best available evidence for the use of ctDNA in early-stage colon cancer. Observational cohorts have established MRD after surgery as a significant prognostic factor for recurrence in stage II and III colon cancer. It also has the ability to anticipate clinical recurrence before standard investigations when used in surveillance. The first and only interventional randomized trial to date evaluating ctDNA is DYNAMIC. The study demonstrated the noninferiority of a MRD detection-guided approach in selecting patients with stage II colon cancer for adjuvant treatment. Notwithstanding the important results, there are still important questions to be answered before ctDNA enters prime time in the clinic. However, future appears bright and ongoing trials will help clarify how to best use this technology in early-stage colon cancer.

Objectives: We investigated if Xpert MTB/RIF (Xpert) testing on urine samples among newly diagnosed HIV-patients as an adjunctive test to Xpert testing on sputum increases diagnosis. We sought to define subgroups of patients, for whom testing with either test is especially advantageous. Methods: We included patients >15 years, newly diagnosed with HIV, that delivered a urine sample on the day of HIV-diagnosis at the biggest HIV-clinic in Guinea-Bissau between September 5, 2016 and October 13, 2017 into a cross-sectional study. Patients were asked for a sputum sample, which was Xpert tested if returned within 30 days. A questionnaire and physical examination were completed on day of inclusion. Results: We included 390 patients. TB prevalence was 12.6%. Adding Xpert urine test to all newly diagnosed HIV-patients increased diagnostic yield of TB by 58% compared with testing on sputum alone. Patients who tested positive by Xpert on urine samples were clinically similar to those tested with sputum, except that the sputum positives reported more cough (p=0.03). Conclusions: Indiscriminate Xpert urine testing in newly diagnosed HIV-patients with advanced disease increased diagnostic yield. Xpert testing for TB on urine and sputum should be offered as screening in Guinea-Bissau and possibly in similar settings.

Hutchinson-Gilford Progeria Syndrome (HGPS) is a rare genetic disorder that causes accelerated aging and a high risk of cardiovascular complications. However, the underlying mechanisms of cardiac complications of this syndrome are not fully understood. This study modeled HGPS using cardiomyocytes (CM) derived from induced pluripotent stem cells (iPSC) derived from a patient with HGPS and characterized the biophysical, morphological, and molecular changes found in these CM compared to CM derived from a healthy donor. Electrophysiological recordings suggest that the HGPS-CM was functional and had normal electrophysiological properties. Electron tomography showed nuclear morphology alteration, and the 3D reconstruction of electron tomography images suggests structural abnormalities in HGPS-CM mitochondria, however, there was no difference in mitochondrial content as measured by Mitotracker. Immunofluorescence indicates nuclear morphological alteration and confirms the presence of Troponin T. Telomere length was measured using qRT-PCR, and no difference was found in the CM from HGPS when compared to the control. Proteomic analysis was carried out in a high-resolution system using Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS). The proteomics data show distinct group separations and protein expression differences between HGPS and control-CM, highlighting changes in ribosomal, TCA cycle, and amino acid biosynthesis, among other modifications. Our findings show that iPSC-derived cardiomyocytes from a Progeria Syndrome patient have significant changes in mitochondrial morphology and protein expression, implying novel mechanisms underlying premature cardiac aging.